Does insurance cover adolescent residential recovery? If you are searching for answers to this question, most likely your child or teenager can benefit from participating in residential treatment. A residential care program can support your child’s mental health by teaching them healthy ways of coping with depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and other treatable conditions.
HillsidesCares is a full-service mental health treatment center that welcomes children who are struggling to keep up in school due to depression or anxiety symptoms. We have a number of programs that are covered by most insurance plans, and we will submit all paperwork and discuss how much they cover and any out-of-pocket expenses. Our Pasadena adolescent treatment program is for children as young as six years old, and we will develop a comprehensive program that will teach them how to better manage their symptoms and triggers.
Does insurance cover adolescent residential recovery?
An insurance policy can cover many things, from your home and auto to healthcare, dental care, and vision care. But what about mental health care? Mental illness is very common in the U.S. According to the Centers for Disease Control and Prevention (CDC), one in six children experiences a mental health illness each year1. The most common conditions that affect children include:
- Anxiety disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorder (ASD)
- Eating disorders
- Depression disorders
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
Does insurance cover adolescent residential recovery? Yes. Most insurance companies do offer coverage for residential treatment programs, but the amount they will pay varies depending on the program you choose. Most treatment centers will list the insurance companies they work with and are in-network.
Why do insurance companies deny recovery?
Insurance companies can deny coverage for various reasons. If the treatment program is experimental and not covered by any specific plan, they can deny coverage and suggest going with a program that is covered.
Why do insurance companies deny coverage? Some of the reasons why they could deny your claim include:
- Medical necessity: Insurance companies want documentation that explains why your child needs residential treatment. This includes clinical evaluations, diagnostic codes, and an effective treatment plan.
- Level of care: Residential care is very costly, and unless proven necessary, they may deny your claim and suggest a less costly alternative.
- Pre-authorization: Some insurance plans may require pre-authorization before sending payment. Failure to get a pre-authorization may lead to your claim being denied.
- Network status: Insurance companies only cover specific treatment centers and programs. Check with the treatment center to see if they have a list of insurance companies that they work with.
- Cost: Insurance providers are cost-driven and may deny any claims that they feel are too expensive.
Treatment centers have insurance experts who’ll file your paperwork for you and go over your benefits and what specifically is covered. They will discuss out-of-pocket expenses and help you find ways to cover them.
Who pays for residential treatment?
If your child’s mental health is in jeopardy and they need a residential treatment plan, many insurance companies have plans that will cover most, if not all, of the cost of residential treatment.
Is residential treatment covered by insurance plans? The following is a breakdown of an average insurance plan that covers residential treatment:
What is covered?
If a residential program is deemed necessary, you’re in luck. Insurance companies offer plans that include mental health coverage. It covers room and board, 24/7 supervision and care, along with:
- Mental health evaluations
- Psychiatric services
- Individual, group, and family therapy
- Medication management
Your plan will list everything they cover and any requirements for coverage.
Who pays for residential treatment?
All insurance companies are cost-driven and will have specific deductibles and co-pays that you are responsible for. The following is an example of an average plan:
- Deductible: This is the initial payment that’s due before coverage begins and is around $1,000 to $5,000 annually.
- Co-payments: This is generally between $10 and $75 per session and depends on the type of policy you have.
- Co-insurance: This is the percentage of the cost for treatment that you are responsible for. Coinsurance rates run from 10%–30%.
- Out-of-pocket costs: Your out-of-pocket costs can vary wildly and include your deductible, copayments, and coinsurance.
The average out-of-pocket cost per session is between $20 and $100 per session. Without an insurance plan, the cost can be as much as $500 per day or more.
What insurance companies offer residential coverage?
Not all insurance companies are the same and will have different coverage options and benefits. Here is a list of the insurance companies that offer residential coverage:
- Aetna
- Blue Cross Blue Shield
- Cigna
- Humana
- Kaiser Permanente
- Magellan Health
- Moline Health
- UnitedHealthcare
Which therapies do insurance companies cover?
Insurance companies cover a number of standard therapeutic methods for treating mental health conditions, including:
- Cognitive-behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Trauma-informed care
- Family therapy
They cover medication management programs to ease symptoms and allow children to focus on their recovery. Depending on the program, they may also cover educational programs to continue their education.
The best way to understand what your policy covers is to know what is covered and what isn’t. Go over your policy and ask questions if you don’t understand something. Document everything and keep detailed records of any correspondence with your insurance company. Before enrolling your child, obtain any pre-authorizations from your insurance provider, and always advocate for your child in case of any denials or limitations.
Join our Pasadena adolescent treatment program today at HillsidesCares
Is residential treatment covered under insurance? Yes. HillsidesCares accepts most major insurance companies to support your child who is struggling with depression, anxiety, or other treatable mental health illnesses. We have a working relationship with Anthem, Blue Cross, Blue Shield of California, Caelon Behavioral Health, Evernorth Behavioral Health, Kaiser Permanente, and other insurance providers. Our team will take care of filing all necessary paperwork and help you find other ways to pay for any out-of-pocket costs you are responsible for.
For more information about which insurance companies we work with, fill out our online contact form or call 323.641.4842 today to speak with our dedicated team.
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